Malaria surveillance, monitoring and evaluation: a reference manual, 2nd ed.

Q: When should a country transition from aggregate to case-based malaria reporting?

The manual suggests monthly aggregate reporting is sufficient when incidence is high (≥100 confirmed cases per 1,000 population at risk), weekly reporting when moderate (10–100 per 1,000), and immediate individual case notification when incidence is very low (<1 per 1,000) or zero. However, the thresholds are not rigid; if a country has capacity and resources aligned with elimination goals, case-based data collection may be initiated earlier in higher transmission settings.

Q: What is a master list and why is it important for malaria surveillance?

A master list is an authoritative set of uniquely coded, georeferenced active records of all health facilities and points of care that serves as a single source of truth across programmes. It is foundational for disease surveillance because it enables confident measurement of reporting completeness, accurate visualization of spatial disease patterns, identification of gaps in access to care, and cross-tabulation of variables from different information systems. Without master lists, programmes face challenges with missing geographical information, incomplete denominators, and inability to link intervention coverage data with disease outcomes.

Q: What are the core data quality metrics that should be routinely monitored?

The manual identifies eight core metrics: (1) consistency of case definitions with WHO standards; (2) completeness of facility reporting (proportion of expected reports received); (3) timeliness of reporting; (4) completeness of core variables within reports; (5) consistency between related core variables (e.g., confirmed cases cannot exceed cases tested); (6) consistency of indicator trends over time (minimum 3 years); (7) concordance between different electronic reporting systems; and (8) concordance between the surveillance system and source data such as patient registers. These should be assessed through both desk-level and service-level assessments.

Q: How should surveillance differ in elimination settings compared to burden reduction settings?

In elimination settings, surveillance becomes more intensive: every suspected case must be tested and every confirmed case immediately notified (within 24 hours), investigated, and classified by origin (indigenous, imported, introduced, induced, relapsing, or recrudescent). Case investigation should occur within 24–48 hours, focus investigation within 1 week. Active case detection (both reactive and proactive) supplements passive case detection. Individual patient data including contact information, travel history, occupation, GPS coordinates of household, ITN use, and IRS receipt must be recorded. Private sector reporting becomes mandatory by law. In burden reduction settings, monthly aggregate data by age and sex may be sufficient, and universal case investigation is not required.

WHOManualCurrent editionCC BY-NC-SA 3.0 IGO

World Health Organization · 2nd edition, 2025 · 237 pages

Comprehensive operational guidance for transforming malaria surveillance into a core intervention across all transmission settings for national programme staff.

In one sentenceMalaria surveillance must evolve from monthly aggregate reporting in high-burden settings to immediate individual case notification with investigation within 24–48 hours in elimination settings, supported by quality-assured diagnosis, master facility lists, digital systems, and inclusion of all sectors.

Issuer: World Health Organization
Edition: 2nd edition, 2025
Audience: Staff in ministries of health, national malaria programmes, health information system units, partners involved in malaria surveillance, and WHO officers advising countries on malaria surveillance; relevant for all malaria transmission settings
Evidence: Operational guidance based on expert consensus, WHO technical consultations, Malaria Strategic Information Technical Advisory Group reviews, country surveillance practices, and alignment with Global technical strategy for malaria 2016–2030
Reviewed: 17 Oct 2026 · GMJ

Read the original on WHO Download PDF (237 pp)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 17 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This second edition provides comprehensive guidance on integrating malaria surveillance as a core intervention across all malaria transmission settings, from high-burden areas to elimination and prevention of re-establishment. It emphasizes transforming surveillance into a dynamic tool that informs programmatic decision-making, resource allocation, and intervention planning by leveraging surveillance data to efficiently target interventions, prevent outbreaks, guide elimination, and mitigate re-establishment risks.

Key components include establishing robust surveillance systems for detecting malaria cases, monitoring intervention coverage, and evaluating programme performance. The manual outlines methodologies for data collection, analysis, and reporting tailored to varying transmission intensities, and provides strategies for integrating surveillance data with broader health information systems. It addresses critical gaps including weak data quality, incomplete case detection, and inadequate epidemic preparedness.

The manual covers seven main areas: surveillance as a core intervention; establishing surveillance systems; concepts and practice of surveillance including case detection, classification, and focus investigation; surveillance of antimalarial drug efficacy and resistance; entomological surveillance and vector control monitoring; early warning and response to epidemics; and monitoring and evaluation of national programmes. Practical tools include standardized indicators, data visualization methods, and case studies for implementation at national and subnational levels.

Key points

For clinicians — doses and thresholds as stated in the guideline

All suspected malaria cases must be confirmed by quality-assured microscopy or WHO-recommended rapid diagnostic tests (RDTs) before treatment
In high/moderate transmission settings: monthly aggregate reporting is sufficient; in low transmission: weekly reporting; in very low/elimination settings: immediate individual case notification required
Case investigation must be completed within 24–48 hours of notification, with focus investigation within 1 week in elimination settings
Master lists of all health facilities with geographical coordinates are foundational for accurate disease surveillance and resource allocation
Data quality metrics include completeness of facility reporting, timeliness, completeness of core variables within reports, and consistency between related indicators
In elimination settings, cases must be classified as indigenous, imported, introduced, induced, relapsing, or recrudescent, with travel history documented
Active case detection (both reactive and proactive) is required in low transmission and elimination settings, not just passive case detection
Three or more indigenous malaria cases of the same species per year in the same focus for 3 consecutive years defines re-establishment of transmission

Data quality metrics for malaria surveillance systems

Table extracted from the guideline

Metric	Definition
Consistency of case definitions	Definition of malaria case consistent with WHO malaria terminology, 2021 update
Completeness of facility reporting	Proportion of expected reports that were received in a specified period
Timeliness of facility reporting	Proportion of expected reports received by the reporting due date in a specified period
Completeness of core variables within reports	Proportion of reports in which all expected variables are complete, received in a specified period
Consistency between core variables	Proportion of reports in which all consistency checks between core variables are passed (e.g., confirmed cases < cases tested)
Consistency over time for core indicators	Proportion of core indicator trends that are consistent for a specified period (minimum 3 years)
Concordance between electronic reporting systems	Proportion of all core variable values that match between two reporting systems in the same period
Concordance between source data and reference reporting system	Proportion of all core variable values that match between the surveillance system and source data (e.g., patient registers)

Source: World Health Organization, Malaria surveillance, monitoring and evaluation: a reference manual, 2nd ed.. Reproduced in summary form.

What changed in this edition

Versus the previous edition

Aligned with new WHO resources including the second edition of the framework for malaria elimination and the global framework on prevention of re-establishment
Greater emphasis on equity with age- and sex-disaggregated data and consideration of social factors such as literacy and language explicitly listed within surveillance principles
Section 2 updated to focus on digitalization including DHIS2 reporting and introduction of master lists to improve georeferenced health data
Enhanced emphasis on routine data quality assessments to enhance trust and decision-making
Section 2 addresses surveillance for high-risk populations including pregnant women and girls, and at-risk populations in urban areas
Section 3 provides expanded guidelines on reactive interventions and strategies particularly for low-transmission and elimination settings
Section 4 has broader scope with molecular markers of drug resistance included alongside therapeutic efficacy studies
Section 5 shifted towards question-based entomological surveillance focusing on designing projects that inform intervention planning
Section 6 includes new sections on integrating forecasting and early warning systems with climate data to mitigate epidemic risks
Section 7 provides priority indicators and standardized guidance on subnational tailoring and routine surveillance assessments using the Malaria Surveillance Assessment Toolkit
Annex 19 indicator list significantly updated; data collection forms replaced and expanded in Annexes 1–4

From the guideline

Verbatim

“Surveillance is therefore the basis of operational activities in settings of any level of transmission. Its objective is to reduce the burden of malaria, eliminate the disease and prevent its re-establishment.”

— World Health Organization, Malaria surveillance, monitoring and evaluation: a reference manual, 2nd ed., Section 1.1, page 2 (2025)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As someone who has worked extensively on health information systems and disease surveillance in the South Caucasus, I find this manual's systematic approach to data quality and digitalization particularly relevant for Georgia and neighboring countries. While we eliminated malaria decades ago, the surveillance principles and digital health system frameworks described here—especially the concepts of master facility lists, DHIS2 implementation, and routine data quality assessment metrics—are directly applicable to strengthening our integrated disease surveillance for other communicable diseases and vector-borne threats. I would stress to Georgian colleagues the manual's emphasis on establishing robust data quality assessment processes and master lists as foundational infrastructure, because our experience shows these elements are often overlooked in favor of focusing solely on disease-specific interventions. The realistic caveat is that the transition to fully digital, real-time surveillance systems requires sustained investment in internet connectivity, mobile technology, and ongoing technical support in remote areas, which remains challenging even in middle-income settings like ours, and the manual's frameworks must be adapted to the specific governance structures and health system organization of each country rather than adopted wholesale.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026

Applicability

Georgia and the South Caucasus

While Georgia eliminated malaria in 1970 and was certified malaria-free, this manual remains relevant for the South Caucasus and Eastern Europe region for several reasons. First, Georgia and neighbouring countries maintain receptivity for malaria transmission due to the presence of competent Anopheles vectors and suitable climate, creating vulnerability to re-establishment through imported cases from endemic countries via labour migration, tourism, and refugee movements. Second, the surveillance principles and digital health system approaches described (particularly DHIS2 implementation, master facility lists, and data quality assessment frameworks) are directly applicable to strengthening integrated disease surveillance systems for other vector-borne and communicable diseases across the region. Third, the manual’s guidance on surveillance in mobile and migrant populations, cross-border coordination, and prevention of re-establishment is critical for countries managing health risks associated with population mobility. National programmes in the region should consider adapting the surveillance system assessment tools, data quality metrics, and digital dashboard approaches to enhance their broader communicable disease surveillance capacities, while maintaining vigilance for imported malaria cases that could lead to local transmission.

Questions this guideline answers

Quick answers

When should a country transition from aggregate to case-based malaria reporting?

The manual suggests monthly aggregate reporting is sufficient when incidence is high (≥100 confirmed cases per 1,000 population at risk), weekly reporting when moderate (10–100 per 1,000), and immediate individual case notification when incidence is very low (<1 per 1,000) or zero. However, the thresholds are not rigid; if a country has capacity and resources aligned with elimination goals, case-based data collection may be initiated earlier in higher transmission settings.

What is a master list and why is it important for malaria surveillance?

A master list is an authoritative set of uniquely coded, georeferenced active records of all health facilities and points of care that serves as a single source of truth across programmes. It is foundational for disease surveillance because it enables confident measurement of reporting completeness, accurate visualization of spatial disease patterns, identification of gaps in access to care, and cross-tabulation of variables from different information systems. Without master lists, programmes face challenges with missing geographical information, incomplete denominators, and inability to link intervention coverage data with disease outcomes.

What are the core data quality metrics that should be routinely monitored?

The manual identifies eight core metrics: (1) consistency of case definitions with WHO standards; (2) completeness of facility reporting (proportion of expected reports received); (3) timeliness of reporting; (4) completeness of core variables within reports; (5) consistency between related core variables (e.g., confirmed cases cannot exceed cases tested); (6) consistency of indicator trends over time (minimum 3 years); (7) concordance between different electronic reporting systems; and (8) concordance between the surveillance system and source data such as patient registers. These should be assessed through both desk-level and service-level assessments.

How should surveillance differ in elimination settings compared to burden reduction settings?

In elimination settings, surveillance becomes more intensive: every suspected case must be tested and every confirmed case immediately notified (within 24 hours), investigated, and classified by origin (indigenous, imported, introduced, induced, relapsing, or recrudescent). Case investigation should occur within 24–48 hours, focus investigation within 1 week. Active case detection (both reactive and proactive) supplements passive case detection. Individual patient data including contact information, travel history, occupation, GPS coordinates of household, ITN use, and IRS receipt must be recorded. Private sector reporting becomes mandatory by law. In burden reduction settings, monthly aggregate data by age and sex may be sufficient, and universal case investigation is not required.

Malaria surveillance, monitoring and evaluation: a reference manual, 2nd ed.

What this guideline says

Key points

Data quality metrics for malaria surveillance systems

What changed in this edition

From the guideline

Editor’s perspective

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Applicability

Questions this guideline answers

Related on GMJ

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What this guideline says

Key points

Data quality metrics for malaria surveillance systems

What changed in this edition

From the guideline

Editor’s perspective

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Applicability

Questions this guideline answers

Related on GMJ

Dictionary of Public Health

Conditions A–Z

GMJ News coverage

Quality & accreditation

Other guidelines on this topic

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